What Should Primary Care Look Like in the Future?

I truly hope that very soon I do not have to make an appointment at the GP when I suspect signs of a disease, but my GP will send me a message that she spotted something irregular in my latest test results and my digital health data, so I’d better visit. Let me show you in detail, how primary care should be carried out in the future!

Digital health should become organic part of primary care in the future

Data and digital technology is my guardian and my spear-hand in order to achieve my goals. Just look at my Excel spreadsheet experiment and all the stunning results I could achieve in one year! My GP also thinks that for example activity trackers have a ‘placebo effect’. When you know that your steps are counted, it increases your motivation, boosts your performance and you feel healthier. Thus, I believe digital technology should have a bigger impact in healthcare for making people’s lives better.

Although it is obvious that change starts with the individual, lasting impact can only be reached when the direct environment also resonates with such changes. When people start to turn to digital technology to live a healthier life, the best response would be to advance the closest health sector to the individual, namely primary care in order to reflect the requirements of the 21st century.

So what does primary care look like now? What should be changed?

Healthcare today is not proactive, but rather reactive medicine. Patients usually visit the GP, when they already have some serious problem; and since doctors are overwhelmed with tasks, they can only focus on treating acute illnesses. There is not enough data about the patient, about the possible illness, most GP’s and hospitals do not incorporate the latest proven scientific research into their practice. How could they? Data processing systems are usually not that efficient.

Doctor shortages are global phenomena. The World Health Organization (WHO) estimates that there is a worldwide shortage of around 4.3 million physicians, nurses, and allied health workers. At the same time, the need for healthcare services is rising. Illnesses are becoming easier to catch, civilizational diseases such as diabetes and obesity is on the rise, while aging societies need more and more care. The result? Long waiting hours at the GP or for appointments and surgeries, pricey, long, sometimes unnecessary procedures, random patient management, unequal doctor-patient relationship.

How could we change it?

We need more data and a 180 degree attitude change! Data is essential for getting to know the patients, their situation, and their diseases as well as how to heal them completely and efficiently. Digital technology could help a lot in this respect. Healthcare trackers, sensors and wearables could serve with a swarm of useful biometric data in getting to know the health parameters and vital signs of patients and diagnosing their illnesses.

In January, 2016 a man checked into a hospital’s emergency room in Camden, New Jersey. Because his heart was beating irregularly, doctors suspected he had atrial fibrillation. That is the most common type of arrhythmia, which can increase the risk of stroke. But to decide how to treat him, they needed to know exactly how long his heart had been acting up. That’s when one of the physicians noticed a Fitbit Charge HR on the patient’s wrist; and it had the answers they were looking for.

This example shows perfectly how useful data extracted from wearables could be. That’s why such events should not happen on a randomized basis, but GP’s as well as hospitals should rather incorporate data from healthcare trackers, sensors, even fitness wearables into their practice on a systemic level.

What should the first encounter with your GP’s office in the future look like?

Somewhere in the 2020s. Adam scrolled down on his phone, and asked Mimi, the healthcare chatbot about the selection of GP’s in the neighborhood, where he just moved in. Very neat area in Amsterdam. Based on Adam’s preferences, Mimi offered three possible choices, and he selected one. The chatbot made an appointment for him already for the next day. By the time, he went there, his previous doctor sent over all the necessary healthcare data about him after he consented to the necessary forms about data privacy. Adam could also take all the results of his genetic tests to the GP – data about drug sensitivity, his risks for monogenetic conditions or multifactorial diseases or mutations -; as well as the data from the health trackers, he uses for measuring his physical activity, blood pressure and tracking his sleep.

Adam went to the GP’s office, which rather looked like a business meet-up; and had a very friendly chat with his new doctor, who already knew about his previous knee-replacement operation as well as his peanut allergy. Then she asked a couple of further questions about his health and examined him thoroughly: ECG, blood test, knee X-ray, etc. The whole exam was less than an hour. Afterwards, the doctor gave Adam a summary of the current state of his health and estimated his risk for different diseases. Based on this information, the doctor and Adam worked out a prevention plan how to avoid these health risks and set out the parameters of a personalized healthy lifestyle. They agreed to set up various targets concerning his physical activities, his dieting habits as well as factors reducing stress.

So, the GP will rather act as a health coach in the future: the doctor will interpret health data, if something is not clear, give advice when results are not optimal, while spots and checks irregularities based on data as soon as possible.

What happens in practice?

I always wished Adam’s story could be mine. For years, I have been looking in vain for a GP, who thinks the same way about prevention and digital health as I do. Finally, I found her.

I contacted her, and as my wife and me recently moved to her region, she is now officially my GP. She believes in the equal-level collaboration I’m evangelizing rather than the old hierarchy of the doctor-patient relationship. And she is a data-freak just as myself.

So, I brought to her

the results of my genetic tests: what drugs I’m sensitive to, what metabolic conditions I carry, what major mutations I have (e.g. Leiden that increases my risk for deep vein thrombosis), and what risks I have for multifactorial conditions.

major lab markers from the past years in an Excel spreadsheet so she didn’t have to look through thousands of data points, just what really mattered

the need for a long-term prevention program.

What was my GP’s reaction?

Instead of jumping out of the window in fright from the data-tsunami, she got curious and excited about discovering my health background. First and foremost, she examined all the available information based on my data as well as the data in the healthcare system. Then she drew up my family tree with the major diseases and causes of death, carried out a full physical examination, checked all my tests and lab markers, examined my lifestyle and then came up with the risks for different major conditions based on international data and evidence.

What was the final verdict and how will my GP and I work together in the future?

At the end of the process, we agreed upon a prevention program concerning when and what kind of health tests should I undergo. This is a difficult issue by the way. We could have a full body MRI every year but it is expensive and so far there is no strong evidence that it prolongs life, so we said no. You really need to be considerate and sane while deciding upon a regimen of tests for the long-term. She also gave me pieces of advice about my lifestyle. As I exercise 30 minutes per day on average and never smoked, I can only improve slightly my diet and alcohol intake. But now we know what to keep an eye on:

I have a higher chance for thrombosis

I have to be careful with certain drugs in the future, because the probability of having serious side effects after taking them is high (e.g. statins for high cholesterol)

My chance for melanoma and basal cell carcinoma is very high, so I have to do an annual dermatology checkup

I also have to keep my BMI under 25 because I have a high genetic risk for obesity and insulin resistance

We will meet twice a year if I have no issues (she suggested once a year). In the meantime, I will keep on living a physically, mentally and emotionally active life and measure data. When something is different, I will let her know.

This is what primary care should look like globally. She didn’t order a huge range of additional tests just because she could. We made all these decisions based on evidence. Moreover, she is eager to use the data I bring to the table.

Digital health at its best.

So, how could we help GP’s to incorporate digital health into their everyday practice?

There are many factors which hinder the introduction of digital technologies on the most basic level of healthcare. As my GP said, it is mainly lack of time. Busy physicians find it difficult to incorporate into the everyday practice to work with digital information. Also, there is no separate allocated time to visit your doctor only for preventive visits. So, first of all, we need to make time and space for digital technologies in healthcare. She also mentioned another important factor, the compatibility issue. Medical programs used in the GP’s offices might not be compatible with the health trackers’ own software.

My GP agrees with me that in the last few years there has been a growing interest about health prevention and active involvement in health from the patient’s side. It is not a surprise that there are already examples that patients are bringing their healthcare trackers or sensors to their medical professionals to check their data – and not the other way around.

Healthcare should be put in perspective on a systemic level

Doctors are more traditionally trained to cure illnesses, she added. And I believe this attitude has to change, as technology is at our heels, and we need to keep pace with it. Also, my GP mentioned that the Hungarian system does not reward doctors’ efforts in preventive medicine. This phenomenon is a systemic problem and could be prevalent in other countries as well. She explained that the reimbursement is procedure or capita based and not outcome based. The healthcare system is not “thinking” in terms of prevention mostly because positive results only show after years or even decades on the population level.

Now, that’s the attitude we need to change. You cannot and should not think in short terms in healthcare, because the result will be the usual “firefighting”. We all have to think in perspective about the future of healthcare, and that future must come to terms with digital technology. The sooner, the better.

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